Requirements for improving social capital among faculty members of medical universities: A multicenter qualitative study

Abstract Introduction Social capital is critical to organizational dynamics, particularly in developing countries. This study explored strategies for enhancing social capital among faculty members at seven medical universities in the south of Iran. Methods This qualitative study was conducted in 2021. We used a purposeful sampling technique to recruit faculty members and conducted individual semi‐structured interviews with them. Thematic analysis was used to analyze and describe the collected data. Results A total of 49 faculty members (34 males; 15 females) participated in this study. The participants expressed satisfaction with their affiliations with medical universities. Social capital was related to the feeling of belonging to the organization, as well as to interpersonal and intra‐organizational relations. Social capital was associated with three components: empowerment, organizational policy change, and organizational identification. Additionally, a dynamic relationship between the individual, interpersonal, and macro‐organizational levels reinforced the organization's social capital. This means that, just as the macro‐organizational level affects the members' identities, the members' activism affects the macro‐organizational level. Conclusion To strengthen the organization's social capital, managers should work on the mentioned components at the individual, interpersonal, and macro‐organizational levels.


| INTRODUCTION
Medical schools require qualified and competent faculty members to achieve their educational objectives. 1 Faculty members play the most critical role in improving the quality of educational delivery as they are the primary constituents of universities. 2 Thus, special attention must be paid to these critical and valuable human resources, and strategies for faculty member growth and empowerment must be developed. 3,4 Faculty member development is defined as assisting faculty members in improving their skills, developing more effective curricula, and improving the organizational environment for teaching. 5 One aspect that can be utilized as a part of a faculty member development program is improving social capital. Social capital is a term that refers to the characteristics of a social organization, such as networks, norms, and trust, that emerge from the organization's atmosphere and facilitate coordination and cooperation among its members in pursuit of the common good. 6 Social capital plays a much more significant role in organizations and societies than other capitals, and mass and group relation networks integrate people's relationships with organizations. Without social capital, other capitals become ineffective, and cultural and economic development paths become uneven and complex. 7 Several studies have established the effects of social capital on various components of organizational behavior. A study reported a significant positive relationship between social capital and happiness among faculty members. 8 Enhancing social capital in academic environments has significant benefits and positively affects the entrepreneurial behaviors of university faculty members. Rafiei et al. investigated the relationship between social capital and entrepreneurial behavior among faculty members. The findings indicated that these two variables are positively correlated. 9 Social capital not only affects the performance of the faculty member but can also affect the performance of medical students. 10 In fact, a recent study reported that underperformance by ethnic minority students might be justified through lower levels of social capital. 11 Thus, managers should build social capital within their organizations to foster professional and entrepreneurial performance as well as academic achievements.
To the best of our knowledge, no study has been conducted to determine the factors affecting the social capital of faculty members of medical schools. This qualitative research assessed the most significant obstacles and solutions for increasing the social capital of this target population.

| METHODS
This qualitative study was conducted at seven medical universities (Shiraz, Hormozgan, Bushehr, Yasuj, Jahrom, Larestan, and Fasa universities of medical sciences, referred to as "district five universities") in the south of Iran (links to websites for further details are available in Supporting Information: Table S1). Semistructured interviews were conducted with faculty members of these universities. The protocol for this study was reviewed and approved by the Iranian National Center for Strategic Research in Medical Education.

| Sampling strategy
Purposive sampling was used to select the participants. The sampling procedure was designed to collect participants who were as diverse as possible in terms of gender, university, academic rank, academic field, and experience. Additionally, high-potential faculty members were identified using the Iranian Scientometric Information Database (https://isid.research.ac.ir/). The participants were included if they were employed full-time at one of the mentioned universities and had a minimum of 3 years of work experience. Sampling was carried out until data saturation was achieved. Two research team members independently compared the four most recent interviews with previous interviews to ensure data saturation.

| Data collection
Individual semistructured interviews were conducted face-to-face or via telephone after obtaining the participant's consent. No third parties were present during the interview sessions, and the interviewee and interviewer conversed in a quiet environment. Each participant received an email with a detailed explanation of the research and the interviewer's identity before the interview.

| Data analysis
Data analysis was conducted concurrently with the interviews. The collected data were analyzed using Braun and Clarke's thematic analysis approach. 12 The texts were first reviewed repeatedly by two research team members, after which the initial codes were extracted.
The relationships between the extracted codes were then determined, and subthemes were assigned. Finally, the obtained subthemes were examined, and closely related items were classified into major themes. Any disagreements between the authors were resolved via discussion, and a third author was consulted if necessary.
The authors who participated in this phase came from various executive and scientific backgrounds to mitigate potential bias.
Moreover, critical reflexivity was considered during data analysis to minimize the possibility of bias. Data were analyzed using the MAXQDA 10 software (VERBI GmbH). The data collection and analysis processes included credibility, transferability, confirmability, authenticity, and dependability to ensure the findings were trustworthy. 13 To meet these criteria, the primary investigator was involved throughout the research, the collected data were verified with the participants, the authors checked each other's work, and the sample was selected with the maximum possible variety. Additionally, the standards for qualitative research reporting (SRQR) 14 guidelines were used to improve the reporting and methodological quality.

| RESULTS
We interviewed 49 individuals, including 34 male and 15 female faculty members. The characteristics of the participants are listed in Supporting Information: Table S2. Following data analysis, three major themes and eleven subthemes were identified ( Table 1). The sections that follow summarize the study's most significant findings.

| Empowerment
Empowerment is defined as a collection of training and skills that pave the way for professional development in the organization's collective and participatory activities.

| Conflict resolution
Conflict resolution includes techniques for managing and resolving interpersonal conflicts and clashes. One of the participants stated: "They should train the staff on how to solve their problems in the university hospital environment and how to get along, how to solve the problem, and how to hear opposing ideas and use them to benefit the organization." (No. 5). "Over the years, I have seen several research projects that have failed due to divisiveness and hostility [between colleagues], stemming from a lack of mutual understanding" "What we need to teach is to have diversity among faculty members in the sense that we can bring together professors with different tastes and abilities in the areas of performance, research, education, and treatment" (No. 12).

| Teamwork
Teamwork is defined as a specific way of working that aims to maximize the effectiveness of group abilities and skills. One of the participants said: "Organ transplantation is highly complex, and expectations have risen, so T A B L E 1 Themes, subthemes, and codes.

| Organizational identification
The organization identification theme refers to the process of establishing a culture and a forum for academic discourse and inspirational motivation at the university.

| Appreciation
Appreciation is defined as an awareness of the value of the services provided by employees who have contributed to the organization's growth and development. "The dignity of faculty members must be upheld" (No. 33).
"Leaders are very influential in the organization. Hierarchy, respect, and moral values must be demanded" (No. 21).

| Sense of group identity
A sense of group identity broadly refers to a person's sense of belonging to their place of work within the organization. If they have this sense, individuals desire to work for and grow with the organization. One of the participants said: "Professors should feel that the university has done something for them or contributed to their progress. Whatever memories they have of the university are associated with hope and companionship, which binds them to the institution, so that even if they go to study abroad for a period, they wish to return to their own country despite the attractiveness of the foreign universities" (No. 2).
"I must feel that the university is supporting me. I should feel important to the university. I must feel that the university is proud of me. I must feel that the university acknowledges my concerns" (No. 15).

| A culture of accountability
One of the participants stated: "Many problems and challenges will undoubtedly disappear if everyone in the country is accountable for the task they perform and the responsibility they have taken.
Accountability of each person in the organization effectively provides transparency" (No. 17).

| Fostering a common discourse
Fostering a common discourse refers to the mutual understanding of common knowledge, beliefs, and hypotheses among an organization's employees, achieved through dialog.
One participant said: "We should try to keep the university away from social indifference and isolation and the lack of dialogue between faculty members" (No. 11).
"For example, for the departments of basic medical sciences, we can have meetings about exam validity and reliability, examination standards, rules, student issues, and differences between faculty members. We did this in the hospital and at the university, and we succeeded. We should have similar meetings to share experiences" (No. 19).
"Unfortunately, the current policy is to have faculty members who mind their own business. Do not criticize! Do not talk! Do not disagree! In such a situation, you cannot expect teamwork, innovation, and growth" (No. 31). psychodynamic, and postmodern. 17 Our research primarily focused on the constructivism theory, in which social capital is created through the interaction between individuals and the organization, with interpersonal relationships serving as an intermediary (Figure 1). It has been demonstrated that a person's social capital affects organizational identification, both directly and indirectly, through the perceived attractiveness of the organizational identity. 18 The proposed model's second level (Figure 1) refers to the organization's network of interpersonal relationships, which includes interpersonal communication, conflict resolution, and teamwork. This is consistent with previous research emphasizing the importance of networks in organizations. [19][20][21][22] Gender, specialty, academic level, and college variables affect social capital. 23  members and students should also be examined in future works as it is a component of the organization's social capital. 28

| CONCLUSION
The findings of this study indicate that the following strategies should be adopted to improve social capital among faculty members: (i) empower-

ACKNOWLEDGMENTS
We would like to thank the faculty members who participated in this study. A research grant was provided by Iranian National Center for Strategic Research in Medical Education (No. 994993). The funding body did not play any role in the study design, data collection, analysis, and interpretation, or manuscript writing.